164.502(a)(1)(iii).28 See 45 C.F.R. Treatment, Payment, & Health Care Operations, CDC's web pages on Public Health and HIPAA Guidance, NIH's publication of "Protecting Personal Health Information in Research: Understanding the HIPAAPrivacy Rule. Legally separate covered entities that are affiliated by common ownership or control may designate themselves (including their health care components) as a single covered entity for Privacy Rule compliance.79 The designation must be in writing. Is necessary for State reporting on health care delivery or costs, Is necessary for purposes of serving a compelling public health, safety, or welfare need, and, if a Privacy Rule provision is at issue, if the Secretary determines that the intrusion into privacy is warranted when balanced against the need to be served; or. A use or disclosure of this information that occurs as a result of, or as "incident to," an otherwise permitted use or disclosure is permitted as long as the covered entity has adopted reasonable safeguards as required by the Privacy Rule, and the information being shared was limited to the "minimum necessary," as required by the Privacy Rule.27 See additional guidance on Incidental Uses and Disclosures. michael todd soniclear beeping. 164.512(l).43 45 C.F.R. 200 Independence Avenue, S.W. covered entity has a reasonable belief that the personal representative may be abusing or neglecting the individual, or that treating the person as the personal representative could otherwise endanger the individual. A covered entity must have procedures for individuals to complain about its compliance with its privacy policies and procedures and the Privacy Rule.71 The covered entity must explain those procedures in its privacy practices notice.72. 164.103.79 45 C.F.R. The Department of Justice is responsible for criminal prosecutions under the Priv. 1320d-5.89 Pub. Similarly, a covered entity may rely on an individual's informal permission to use or disclose protected health information for the purpose of notifying (including identifying or locating) family members, personal representatives, or others responsible for the individual's care of the individual's location, general condition, or death. Most uses and disclosures of psychotherapy notes for treatment, payment, and health care operations purposes require an authorization as described below.23 Obtaining "consent" (written permission from individuals to use and disclose their protected health information for treatment, payment, and health care operations) is optional under the Privacy Rule for all covered entities.24 The content of a consent form, and the process for obtaining consent, are at the discretion of the covered entity electing to seek consent. 160.103.13 45 C.F.R. 164.530(k).77 45 C.F.R. Materials in this section are updated as new information and vaccines become available. Accounting for disclosures to health oversight agencies and law enforcement officials must be temporarily suspended on their written representation that an accounting would likely impede their activities. Members of the clergy are not required to ask for the individual by name when inquiring about patient religious affiliation. Required Disclosures. These restrictions must include the representation that the plan sponsor will not use or disclose the protected health information for any employment-related action or decision or in connection with any other benefit plan. 164.530(h).75 45 C.F.R. Individuals have a right to an accounting of the disclosures of their protected health information by a covered entity or the covered entity's business associates.60 The maximum disclosure accounting period is the six years immediately preceding the accounting request, except a covered entity is not obligated to account for any disclosure made before its Privacy Rule compliance date. The Department of Health and Human Services, Office for Civil Rights (OCR) is responsible for administering and enforcing these standards and may conduct complaint investigations and compliance reviews. There are some federal and state privacy laws (e.g., 42 CFR Part 2, Title 10) that require health care providers to obtain patients' written consent before they disclose their health information to other people and organizations, even for treatment. OCR may impose a penalty on a covered entity for a failure to comply with a requirement of the Privacy Rule. 164.506(b).25 45 C.F.R. For more information about medical identity theft, visit the Federal . Certain types of insurance entities are also not health plans, including entities providing only workers' compensation, automobile insurance, and property and casualty insurance. 164.512(e).34 45 C.F.R. GINA covers employers with 15 or more employees, including state and local governments. A covered health care provider may rely on an individual's informal permission to list in its facility directory the individual's name, general condition, religious affiliation, and location in the provider's facility.25 The provider may then disclose the individual's condition and location in the facility to anyone asking for the individual by name, and also may disclose religious affiliation to clergy. Hybrid Entity. Access. 164.530(f).70 45 C.F.R. Affiliated Covered Entity. In certain exceptional cases, the parent is not considered the personal representative. 552a; and (e) information obtained under a promise of confidentiality from a source other than a health care provider, if granting access would likely reveal the source. The Privacy Rule requires a covered entity to treat a "personal representative" the same as the individual, with respect to uses and disclosures of the individual's protected health information, as well as the individual's rights under the Rule.84 A personal representative is a person legally authorized to make health care decisions on an individual's behalf or to act for a deceased individual or the estate. A covered entity must notify the Secretary if it discovers a breach of unsecured protected health information. Is necessary to ensure appropriate State regulation of insurance and health plans to the extent expressly authorized by statute or regulation. 164.105. Such functions include: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.41. The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf. 160.103.92 Fully insured health plans should use the amount of total premiums that they paid for health insurance benefits during the plan's last full fiscal year. See our Combined Regulation Text of All Rules section of our site for the full suite of HIPAAAdministrative Simplification Regulations and Understanding HIPAA for additional guidance material. The plan must receive certification from the plan sponsor that the group health plan document has been amended to impose restrictions on the plan sponsor's use and disclosure of the protected health information. Kenneth Stoller. Workers' Compensation. 164.501.48 45 C.F.R. These standards are intended to protect the privacy of patients. "Summary health information" is information that summarizes claims history, claims expenses, or types of claims experience of the individuals for whom the plan sponsor has provided health benefits through the group health plan, and that is stripped of all individual identifiers other than five digit zip code (though it need not qualify as de-identified protected health information). A covered entity may use and disclose protected health information for its own treatment, payment, and health care operations activities.19 A covered entity also may disclose protected health information for the treatment activities of any health care provider, the payment activities of another covered entity and of any health care provider, or the health care operations of another covered entity involving either quality or competency assurance activities or fraud and abuse detection and compliance activities, if both covered entities have or had a relationship with the individual and the protected health information pertains to the relationship. 45 C.F.R. The . The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. Except in certain circumstances, individuals have the right to review and obtain a copy of their protected health information in a covered entity's designated record set.55 The "designated record set" is that group of records maintained by or for a covered entity that is used, in whole or part, to make decisions about individuals, or that is a provider's medical and billing records about individuals or a health plan's enrollment, payment, claims adjudication, and case or medical management record systems.56 The Rule excepts from the right of access the following protected health information: psychotherapy notes, information compiled for legal proceedings, laboratory results to which the Clinical Laboratory Improvement Act (CLIA) prohibits access, or information held by certain research laboratories. 164.501 and 164.508(a)(3).50 45 C.F.R. For information included within the right of access, covered entities may deny an individual access in certain specified situations, such as when a health care professional believes access could cause harm to the individual or another. Criminal Penalties. 164.502(d)(2), 164.514(a) and (b).15 The following identifiers of the individual or of relatives, employers, or household members of the individual must be removed to achieve the "safe harbor" method of de-identification: (A) Names; (B) All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census (1) the geographic units formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000; (C) All elements of dates (except year) for dates directly related to the individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; (D) Telephone numbers; (E) Fax numbers; (F) Electronic mail addresses: (G) Social security numbers; (H) Medical record numbers; (I) Health plan beneficiary numbers; (J) Account numbers; (K) Certificate/license numbers; (L) Vehicle identifiers and serial numbers, including license plate numbers; (M) Device identifiers and serial numbers; (N) Web Universal Resource Locators (URLs); (O) Internet Protocol (IP) address numbers; (P) Biometric identifiers, including finger and voice prints; (Q) Full face photographic images and any comparable images; and any other unique identifying number, characteristic, or code, except as permitted for re-identification purposes provided certain conditions are met. 164.520(d).54 45 C.F.R. In March 2002, the Department proposed and released for public comment modifications to the Privacy Rule. a notable exclusion of protected health information is quizletsplit bill app. The Vaccine Education Center staff regularly reviews materials for accuracy. 164.526.59 Covered entities may deny an individual's request for amendment only under specified circumstances. 164.502(a)(1).19 45 C.F.R. In the past, family doctors and other health care providers protected the confidentiality of those records by sealing them away in file cabinets and refusing to reveal them to anyone else. 164.504(f).84 45 C.F.R. A health plan satisfies its distribution obligation by furnishing the notice to the "named insured," that is, the subscriber for coverage that also applies to spouses and dependents. 45 C.F.R.
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